Surgical instrument usage data management

ABSTRACT

A surgical instrument operable to sever tissue includes a body assembly and a selectively coupleable end effector assembly. The end effector assembly may include a transmission assembly and an end effector. The body assembly includes a trigger and a casing configured to couple with the transmission assembly. An information transmission system transmits instrument information received from a sensor, for example, to a secure server via a secure gateway connected to the instrument. The instrument may be previously tested on a calibration kit to pre-determine and load surgeon-specific settings onto the instrument prior to use.

BACKGROUND

In some settings, endoscopic surgical instruments may be preferred overtraditional open surgical devices since a smaller incision may reducethe post-operative recovery time and complications. Consequently, someendoscopic surgical instruments may be suitable for placement of adistal end effector at a desired surgical site through a cannula of atrocar. These distal end effectors may engage tissue in a number of waysto achieve a diagnostic or therapeutic effect (e.g., endocutter,grasper, cutter, stapler, clip applier, access device, drug/gene therapydelivery device, and energy delivery device using ultrasound, RF, laser,etc.). Endoscopic surgical instruments may include a shaft between theend effector and a handle portion, which is manipulated by theclinician. Such a shaft may enable insertion to a desired depth androtation about the longitudinal axis of the shaft, thereby facilitatingpositioning of the end effector within the patient.

Examples of endoscopic surgical instruments include those disclosed inU.S. Pat. No. 7,416,101 entitled “Motor-Driven Surgical Cutting andFastening Instrument with Loading Force Feedback,” issued Aug. 26, 2008,the disclosure of which is incorporated by reference herein; U.S. Pat.No. 7,738,971 entitled “Post-Sterilization Programming of SurgicalInstruments,” issued Jun. 15, 2010, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2006/0079874 entitled“Tissue Pad for Use with an Ultrasonic Surgical Instrument,” publishedApr. 13, 2006, now abandoned, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2007/0191713 entitled “Ultrasonic Devicefor Cutting and Coagulating,” published Aug. 16, 2007, now abandoned,the disclosure of which is incorporated by reference herein; U.S. Pub.No. 2007/0282333 entitled “Ultrasonic Waveguide and Blade,” publishedDec. 6, 2007, now abandoned, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2008/0200940 entitled “Ultrasonic Devicefor Cutting and Coagulating,” published Aug. 21, 2008, now abandoned,the disclosure of which is incorporated by reference herein; U.S. Pat.Pub. No. 2009/0143797, entitled “Cordless Hand-held Ultrasonic CauteryCutting Device,” published Jun. 4, 2009, issued as U.S. Pat. No.8,419,757 on Apr. 16, 2013, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2009/0209990 entitled “MotorizedSurgical Cutting and Fastening Instrument Having Handle Based PowerSource,” published Aug. 20, 2009, issued as U.S. Pat. No. 8,657,174 onFeb. 25, 2014, the disclosure of which is incorporated by referenceherein; U.S. Pub. No. 2010/0069940 entitled “Ultrasonic Device forFingertip Control,” published Mar. 18, 2010, issued as U.S. Pat. No.9,023,071 on May 5, 2015, the disclosure of which is incorporated byreference herein; and U.S. Pub. No. 2011/0015660, entitled “RotatingTransducer Mount for Ultrasonic Surgical Instruments,” published Jan.20, 2011, issued as U.S. Pat. No. 8,461,744 on Jun. 11, 2013, thedisclosure of which is incorporated by reference herein. Similarly,various ways in which medical devices may be adapted to include aportable power source are disclosed in U.S. Provisional Application Ser.No. 61/410,603, filed Nov. 5, 2010, entitled “Energy-Based SurgicalInstruments,” the disclosure of which is incorporated by referenceherein.

Additional examples endoscopic surgical instruments include aredisclosed in U.S. Pat. No. 6,500,176 entitled “Electrosurgical Systemsand Techniques for Sealing Tissue,” issued Dec. 31, 2002, the disclosureof which is incorporated by reference herein; U.S. Pat. No. 7,112,201entitled “Electrosurgical Instrument and Method of Use,” issued Sep. 26,2006, the disclosure of which is incorporated by reference herein; U.S.Pat. No. 7,125,409, entitled “Electrosurgical Working End for ControlledEnergy Delivery,” issued Oct. 24, 2006, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 7,169,146 entitled“Electrosurgical Probe and Method of Use,” issued Jan. 30, 2007, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.7,186,253, entitled “Electrosurgical Jaw Structure for Controlled EnergyDelivery,” issued Mar. 6, 2007, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 7,189,233, entitled “ElectrosurgicalInstrument,” issued Mar. 13, 2007, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 7,220,951, entitled“Surgical Sealing Surfaces and Methods of Use,” issued May 22, 2007, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.7,309,849, entitled “Polymer Compositions Exhibiting a PTC Property andMethods of Fabrication,” issued Dec. 18, 2007, the disclosure of whichis incorporated by reference herein; U.S. Pat. No. 7,311,709, entitled“Electrosurgical Instrument and Method of Use,” issued Dec. 25, 2007,the disclosure of which is incorporated by reference herein; U.S. Pat.No. 7,354,440, entitled “Electrosurgical Instrument and Method of Use,”issued Apr. 8, 2008, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 7,381,209, entitled “ElectrosurgicalInstrument,” issued Jun. 3, 2008, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2011/0087218, entitled“Surgical Instrument Comprising First and Second Drive SystemsActuatable by a Common Trigger Mechanism,” published Apr. 14, 2011,issued as U.S. Pat. No. 8,939,974 on Jan. 27, 2015, the disclosure ofwhich is incorporated by reference herein; U.S. patent application Ser.No. 13/151,481, entitled “Motor Driven Electrosurgical Device withMechanical and Electrical Feedback,” filed Jun. 2, 2011, issued as U.S.Pat. No. 9,161,803 on Oct. 20, 2015, the disclosure of which isincorporated by reference herein; U.S. patent application Ser. No.13/269,870, entitled “Surgical Instrument with Modular Shaft and EndEffector,” filed Oct. 10, 2011, issued as U.S. Pat. No. 9,510,895 onDec. 6, 2016, the disclosure of which is incorporated by referenceherein; U.S. patent application Ser. No. 13/235,660, entitled“Articulation Joint Features for Articulating Surgical Device,” filedSep. 19, 2011, issued as U.S. Pat. No. 9,402,682 on Aug. 2, 2016, thedisclosure of which is incorporated by reference herein; U.S. patentapplication Ser. No. 13/274,805, entitled “Surgical Instrument withModular End Effector,” filed Oct. 17, 2011, issued as U.S. Pat. No.8,998,939 on Apr. 7, 2015, the disclosure of which is incorporated byreference herein; U.S. patent application Ser. No. 13/276,725, entitled“Medical Device Usage Data Processing,” filed Oct. 19, 2011, issued asU.S. Pat. No. 9,095,346 on Aug. 4, 2015, the disclosure of which isincorporated by reference herein; and U.S. patent application Ser. No.13/276,660, entitled “User Feedback Through Handpiece of SurgicalInstrument,” filed Oct. 19, 2011, issued as U.S. Pat. No. 9,364,279 onJun. 14, 2016, the disclosure of which is incorporated by referenceherein.

In addition, the surgical instruments may be used, or adapted for use,in robotic-assisted surgery settings such as that disclosed in U.S. Pat.No. 6,783,524, entitled “Robotic Surgical Tool with UltrasoundCauterizing and Cutting Instrument,” issued Aug. 31, 2004.

While several systems and methods have been made and used for surgicalinstruments, it is believed that no one prior to the inventors has madeor used the invention described in the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim this technology, it is believed this technologywill be better understood from the following description of certainexamples taken in conjunction with the accompanying drawings, in whichlike reference numerals identify the same elements and in which:

FIG. 1 depicts a schematic view of an exemplary surgical systemcomprising a medical device having a power source and a cartridge;

FIG. 2 depicts a perspective view of an exemplary ultrasonic surgicalsystem comprising a surgical instrument and a generator;

FIG. 3A depicts a cross-sectional side view another exemplary surgicalsystem comprising a surgical instrument with a transducer removed and adetachable end effector;

FIG. 3B depicts a cross-sectional side view of the surgical instrumentof FIG. 3A with the transducer attached and the detachable end effectorattached;

FIG. 4 depicts a side elevation view of an exemplary electrosurgicalmedical device;

FIG. 5 depicts a perspective view of the end effector of the device ofFIG. 4, in an open configuration;

FIG. 6A depicts a side elevation view of a first exemplary couplingmechanism with a portion of a handle assembly in cross-section to showthe interior thereof and showing a decoupled end effector assembly;

FIG. 6B depicts a side elevation view of the coupling mechanism of FIG.6A showing the end effector assembly coupled to the handle assembly;

FIG. 7 depicts a schematic view of an exemplary information transmissionsystem;

FIG. 8A depicts a first portion of a flowchart showing an exemplary useof the information transmission system of FIG. 7;

FIG. 8B depicts a second, continued portion of a flowchart showing anexemplary use of the information transmission system of FIG. 7;

FIG. 9 depicts a graphical view of data transmitted from an exemplarysensor of an exemplary medical device;

FIG. 10 depicts a first graphical view of electrical characteristicsassociated with a generator and a medical device during a procedure;

FIG. 11 depicts a second graphical view of electrical characteristicsassociated with a generator and a medical device during a procedure;

FIG. 12 depicts a third graphical view of electrical characteristicsassociated with a generator and a medical device during a procedure;

FIG. 13A depicts a first portion of a flowchart showing an exemplary useof an exemplary calibration kit with a medical device; and

FIG. 13B depicts a second, continued portion of a flowchart showing anexemplary use of an exemplary calibration kit with a medical device.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the technology may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presenttechnology, and together with the description serve to explain theprinciples of the technology; it being understood, however, that thistechnology is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the technology shouldnot be used to limit its scope. Other examples, features, aspects,embodiments, and advantages of the technology will become apparent tothose skilled in the art from the following description, which is by wayof illustration, one of the best modes contemplated for carrying out thetechnology. As will be realized, the technology described herein iscapable of other different and obvious aspects, all without departingfrom the technology. Accordingly, the drawings and descriptions shouldbe regarded as illustrative in nature and not restrictive.

It should be understood that the teachings below may be readily appliedto any of the references that are cited herein. Various suitable ways inwhich the below teachings may be combined with the references citedherein will be apparent to those of ordinary skill in the art.

It is further understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Thefollowing-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

I. Overview of Exemplary Surgical Instrument

FIG. 1 shows components of an exemplary medical device (10) indiagrammatic block form. As shown, medical device (10) comprises acontrol module (12), a power source (14), and an end effector (16).Merely exemplary power sources (14) may include NiMH batteries, Li-ionbatteries (e.g., prismatic cell type lithium ion batteries, etc.),Ni-Cad batteries, or any other type of power source as may be apparentto one of ordinary skill in the art in light of the teachings herein.Control module (12) may comprise a microprocessor, an applicationspecific integrated circuit (ASIC), memory, a printed circuit board(PCB), a storage device (such as a solid state drive or hard disk),firmware, software, or any other suitable control module components aswill be apparent to one of ordinary skill in the art in light of theteachings herein. Control module (12) and power source (14) are coupledby an electrical connection (22), such as a cable and/or traces in acircuit board, etc., to transfer power from power source (14) to controlmodule (12). Alternatively, power source (14) may be selectively coupledto control module (12). This allows power source (14) to be detached andremoved from medical device (10), which may further allow power source(14) to be readily recharged or reclaimed for resterilization and reuse,such as in accordance with the various teachings herein. In addition orin the alternative, control module (12) may be removed for servicing,testing, replacement, or any other purpose as will be apparent to one ofordinary skill in the art in view of the teachings herein.

End effector (16) is coupled to control module (12) by anotherelectrical connection (22). End effector (16) is configured to perform adesired function of medical device (10). By way of example only, suchfunction may include cauterizing tissue, ablating tissue, severingtissue, ultrasonically vibrating, stapling tissue, or any other desiredtask for medical device (10). End effector (16) may thus include anactive feature such as an ultrasonic blade, a pair of clamping jaws, asharp knife, a staple driving assembly, a monopolar RF electrode, a pairof bipolar RF electrodes, a thermal heating element, and/or variousother components. End effector (16) may also be removable from medicaldevice (10) for servicing, testing, replacement, or any other purpose aswill be apparent to one of ordinary skill in the art in view of theteachings herein and as described with respect to FIGS. 3A-3B below. Insome versions, end effector (16) is modular such that medical device(10) may be used with different kinds of end effectors (e.g., as taughtin U.S. Provisional Application Ser. No. 61/410,603, etc.). Variousother configurations of end effector (16) may be provided for a varietyof different functions depending upon the purpose of medical device (10)as will be apparent to those of ordinary skill in the art in view of theteachings herein. Similarly, other types of components of a medicaldevice (10) that may receive power from power source (14) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

Medical device (10) of the present example includes a trigger (18) and asensor (20), though it should be understood that such components aremerely optional. Trigger (18) is coupled to control module (12) andpower source (14) by electrical connection (22). Trigger (18) may beconfigured to selectively provide power from power source (14) to endeffector (16) (and/or to some other component of medical device (10)) toactivate medical device (10) when performing a procedure. Sensor (20) isalso coupled to control module (12) by an electrical connection (22) andmay be configured to provide a variety of information to control module(12) during a procedure. By way of example only, such configurations mayinclude sensing impedance in tissue at end effector (16), sensing atemperature at end effector (16), determining movement and/ororientation of end effector (16), or determining the oscillation rate ofend effector (16). Data from sensor (20) may be processed by controlmodule (12) to effect the delivery of power to end effector (16) (e.g.,in a feedback loop, etc.). Various other configurations of sensor (20)may be provided depending upon the purpose of medical device (10) aswill be apparent to those of ordinary skill in the art in view of theteachings herein. Of course, as with other components described herein,medical device (10) may have more than one sensor (20), or sensor (20)may simply be omitted if desired. Sensor (20) of medical device (10) maybe operable in accordance with the teachings of U.S. patent applicationSer. No. 13/276,725, issued as U.S. Pat. No. 9,095,346 on Aug. 4, 2015,the disclosure of which is incorporated by reference herein.

In some versions, a cartridge (26) and generator (28) are attached tomedical device (10) via cable (30). For instance, generator (28) mayserve as a substitute for power source (14). While medical device (10)is shown as being in communication with both cartridge (26) andgenerator (28) via cables (30), it should be understood that medicaldevice (10) may alternatively communicate with one or both of cartridge(26) and generator (28) via a wireless communication.

II. Overview of Exemplary Ultrasonic Surgical System

FIG. 2 depicts a merely exemplary form that medical device (10) maytake. FIG. 2 shows an exemplary ultrasonic surgical system (24)comprising an ultrasonic surgical instrument (50), a cartridge (26), agenerator (28), and a cable (30) operable to couple generator (28) tosurgical instrument (50). A suitable generator (28) is the GEN 300 soldby Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. By way of exampleonly, generator (28) may be constructed in accordance with the teachingsof U.S. Pub. No. 2011/0087212, entitled “Surgical Generator forUltrasonic and Electrosurgical Devices,” published Apr. 14, 2011, issuedas U.S. Pat. No. 8,986,302 on Mar. 24, 2015, and U.S. patent applicationSer. No. 13/269,870, entitled “Surgical Instrument with Modular Shaftand End Effector,” filed Oct. 10, 2011, issued as U.S. Pat. No.9,510,895 on Dec. 6, 2016, the disclosures of which are incorporated byreference herein. It should be noted that surgical instrument (50) willbe described in reference to an ultrasonic surgical instrument; however,the technology described below may be used with a variety of surgicalinstruments, including, but not limited to, endocutters, graspers,cutters, staplers, clip appliers, access devices, drug/gene therapydelivery devices, and energy delivery devices using ultrasound, RF,laser, etc., and/or any combination thereof as will be apparent to oneof ordinary skill in the art in view of the teachings herein. Moreover,while the present example will be described in reference to acable-connected surgical instrument (50), it should be understood thatsurgical instrument (50) may be adapted for cordless operation, such asthat disclosed in U.S. Pat. Pub. No. 2009/0143797, entitled “CordlessHand-held Ultrasonic Cautery Cutting Device,” published Jun. 4, 2009,issued as U.S. Pat. No. 8,419,757 on Apr. 16, 2013, the disclosure ofwhich is incorporated by reference herein. Furthermore, surgical device(50) may also be used, or adapted for use, in robotic-assisted surgerysettings such as that disclosed in U.S. Pat. No. 6,783,524, entitled“Robotic Surgical Tool with Ultrasound Cauterizing and CuttingInstrument,” issued Aug. 31, 2004.

Surgical instrument (50) of the present example includes a multi-piecehandle assembly (60), an elongated transmission assembly (70), and atransducer (100). Transmission assembly (70) is coupled to multi-piecehandle assembly (60) at a proximal end of transmission assembly (70) andextends distally from multi-piece handle assembly (60). In the presentexample transmission assembly (70) is configured to be an elongated,thin tubular assembly for endoscopic use, but it should be understoodthat transmission assembly (70) may alternatively be a short assembly,such as those disclosed in U.S. Pat. Pub. No. 2007/0282333, entitled“Ultrasonic Waveguide and Blade,” published Dec. 6, 2007, now abandoned,and U.S. Pat. Pub. No. 2008/0200940, entitled “Ultrasonic Device forCutting and Coagulating,” published Aug. 21, 2008, now abandoned, thedisclosures of which are incorporated by reference herein. Transmissionassembly (70) of the present example comprises an outer sheath (72), aninner tubular actuating member (not shown), a waveguide (not shown), andan end effector (80) located on the distal end of transmission assembly(70). In the present example, end effector (80) comprises a blade (82)coupled to the waveguide, a clamp arm (84) operable to pivot at theproximal end of transmission assembly (70), and, optionally, one or moreclamp pads (86) coupleable to clamp arm (84). It should also beunderstood that clamp arm (84) and associated features may beconstructed and operable in accordance with at least some of theteachings of U.S. Pat. No. 5,980,510, entitled “Ultrasonic ClampCoagulator Apparatus Having Improved Clamp Arm Pivot Mount,” issued Nov.9, 1999, the disclosure of which is incorporated by reference herein.The waveguide, which is adapted to transmit ultrasonic energy from atransducer (100) to blade (82), may be flexible, semi-flexible, orrigid. One merely exemplary ultrasonic transducer (100) is Model No.HP054, sold by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. Thewaveguide may also be configured to amplify the mechanical vibrationstransmitted through the waveguide to blade (82) as is well known in theart. The waveguide may further have features to control the gain of thelongitudinal vibration along the waveguide and features to tune thewaveguide to the resonant frequency of the system.

In the present example, the distal end of the blade (82) is disposednear an anti-node in order to tune the acoustic assembly to a preferredresonant frequency f_(o) when the acoustic assembly is not loaded bytissue. When transducer (100) is energized, the distal end of blade (82)is configured to move longitudinally in the range of, for example,approximately 10 to 500 microns peak-to-peak, and preferably in therange of about 20 to about 200 microns at a predetermined vibratoryfrequency f_(o) of, for example, 55.5 kHz. When transducer (100) of thepresent example is activated, these mechanical oscillations aretransmitted through the waveguide to end effector (80). In the presentexample, blade (82), being coupled to the waveguide, oscillates at theultrasonic frequency. Thus, when tissue is secured between blade (82)and clamp arm (84), the ultrasonic oscillation of blade (82) maysimultaneously sever the tissue and denature the proteins in adjacenttissue cells, thereby providing a coagulative effect with relativelylittle thermal spread. An electrical current may also be providedthrough blade (82) and clamp arm (84) to also cauterize the tissue.While some configurations for transmission assembly (70) and transducer(100) have been described, still other suitable configurations fortransmission assembly (70) and transducer (100) will be apparent to oneor ordinary skill in the art in view of the teachings herein.

Multi-piece handle assembly (60) of the present example comprises amating housing portion (62) and a lower portion (64). Mating housingportion (62) is configured to receive transducer (100) at a proximal endof mating housing portion (62) and to receive the proximal end oftransmission assembly (70) at a distal end of mating housing portion(62). An aperture, described in more detail below, is provided on thedistal end of mating housing portion (62) for insertion of varioustransmission assemblies (70). A rotation knob (66) is shown in thepresent example to rotate transmission assembly (70) and/or transducer(100), but it should be understood that rotation knob (66) is merelyoptional. Lower portion (64) of multi-piece handle assembly (60)includes a trigger (68) and is configured to be grasped by a user usinga single hand. One merely exemplary alternative configuration for lowerportion (64) is depicted in FIG. 1 of U.S. Pat. Pub. No. 2011/0015660,entitled “Rotating Transducer Mount for Ultrasonic SurgicalInstruments,” published Jan. 20, 2011, issued as U.S. Pat. No. 8,461,744on Jun. 11, 2013, the disclosure of which is incorporated by referenceherein. Toggle buttons (not shown) may be located on a distal surface oflower portion (64) and may be operable to activate transducer (100) atdifferent operational levels using generator (28). For instance, a firsttoggle button may activate transducer (100) at a maximum energy levelwhile a second toggle button may activate transducer (100) at a minimum,non-zero energy level. Of course, the toggle buttons may be configuredfor energy levels other than a maximum and/or minimum energy level aswill be apparent to one of ordinary skill in the art in view of theteachings herein. Moreover, the toggle buttons may be located anywhereelse on multi-piece handle assembly (60), on transducer (100), and/orremote from surgical instrument (50), and any number of toggle buttonsmay be provided. While multi-piece handle assembly (60) has beendescribed in reference to two distinct portions (62, 64), it should beunderstood that multi-piece handle assembly (60) may be a unitaryassembly with both portions (62, 64) combined. Multi-piece handleassembly (60) may alternatively be divided into multiple discretecomponents, such as a separate trigger portion (operable either by auser's hand or foot) and a separate mating housing portion (62). Thetrigger portion may be operable to activate transducer (100) and may beremote from mating housing portion (62). Multi-piece handle assembly(60) may be constructed from a durable plastic (such as polycarbonate ora liquid crystal polymer), ceramics and/or metals or any other suitablematerial as will be apparent to one of ordinary skill in the art in viewof the teachings herein. Still other configurations for multi-piecehandle assembly (60) will be apparent to those of ordinary skill in theart in view of the teachings herein. For instance, instrument (50) maybe operated as part of a robotic system. Other configurations formulti-piece handle assembly (60) will also be apparent to those ofordinary skill in the art in view of the teachings herein. By way ofexample only, surgical instrument (50) may be constructed in accordancewith at least some of the teachings of U.S. Pat. No. 5,980,510; U.S.Pat. Pub. No. 2006/0079874, now abandoned; U.S. Pat. Pub. No.2007/0191713, now abandoned; U.S. Pat. Pub. No. 2007/0282333, nowabandoned; U.S. Pat. Pub. No. 2008/0200940, now abandoned; U.S. Pat.Pub. No. 2011/0015660, issued as U.S. Pat. No. 8,461,744 on Jun. 11,2013; U.S. Pat. No. 6,500,176; U.S. Pat. Pub. No. 2011/0087218, issuedas U.S. Pat. No. 8,939,974 on Jan. 27, 2015; and/or U.S. Pat. Pub. No.2009/0143797, issued as U.S. Pat. No. 8,419,757 on Apr. 16, 2013.Additional optional configurations and features for surgical instrument(50) are described in U.S. patent application Ser. No. 13/269,899,entitled “Ultrasonic Surgical Instrument with Modular End Effector,”filed on Oct. 10, 2011, issued as U.S. Pat. No. 9,050,125 on Jun. 9,2015, the disclosure of which is incorporated by reference herein.

FIGS. 3A-3B depict an alternative version of an ultrasonic instrument(101) having a reusable transducer and blade assembly (102) for use in ahandle assembly (120), and a detachable end effector (150). Transducerand blade assembly (102) comprises a transducer (104) and an elongatedblade assembly coupled to transducer (104) and extending distally fromtransducer (104). Traducer (104) is operable to convert electrical powerfrom cable (112) into ultrasonic vibrations at blade (116). Transducer(104) of the present example comprises a transducer body (106), acircumferential notch (108) formed in a distal end of transducer body(106), and a cable (112). Cable (112) of the present example iscoupleable to a power source, such as generator (28) described above, toprovide power to transducer (104). It should be understood thattransducer (104) may be configured to omit cable (112), such as in acordless transducer disclosed in U.S. Pat. Pub. No. 2009/0143797,entitled “Cordless Hand-held Ultrasonic Cautery Cutting Device,”published Jun. 4, 2009, issued as U.S. Pat. No. 8,419,757 on Apr. 16,2013, the disclosure of which is incorporated by reference herein.Components of ultrasonic instrument (101) may be constructed andoperable in accordance with the teachings of U.S. patent applicationSer. No. 13/274,805, issued as U.S. Pat. No. 8,998,939 on Apr. 7, 2015,which is incorporated by reference herein.

In the present example, casing (122) includes a proximal aperture (124)configured to receive transducer and blade assembly (102). Trigger (125)is pivotably coupled to casing (122) and is configured to pivot from anopen position to a closed position. Trigger (125) is configured toactuate outer sheath (138) distally via an actuation assembly (126) whentrigger (125) is in the closed position. Toggle buttons (128) comprisebuttons operable to selectively activate transducer (104) at differentoperational levels using a power source and are operable in accordancewith the teachings of U.S. patent application Ser. No. 13/274,805,issued as U.S. Pat. No. 8,998,939 on Apr. 7, 2015, which is incorporatedby reference herein.

Rotation knob (136) is rotatably coupled to a distal end of casing (122)and is coupled to outer sheath (138) and inner tubular actuation member(140) to rotate outer sheath (138) and inner tubular actuation member(140) relative to casing (122). In some versions, outer sheath (138) andinner tubular actuation member (140) are configured to selectivelycouple to rotation knob (136).

FIG. 3A shows casing (122) with a proximal aperture (124) configured toreceive removable transducer and blade assembly (102). Instrument (101)is capable of accommodating various kinds of transducer and bladeassemblies (102), including those with different types of transducerbodies (106) and/or those with different types of blades (116). Endeffector (150) is shown aligned with outer sheath (138) and innertubular actuation member (140), but in a detached position. Initiallythe user inserts transducer and blade assembly (102) through proximalaperture (124). Assembly (102) is guided through inner tubular actuationmember (140) and out through the distal end of inner tubular actuationmember (140), as shown in FIG. 3B. When transducer and blade assembly(102) is fully inserted, latch member (130) engages notch (108) toretain transducer and blade assembly (102) longitudinally within handleassembly (120). Latch member (130), inner tubular actuation member(140), and transducer and blade assembly (102) may be constructed andoperable in accordance with the teachings of U.S. patent applicationSer. No. 13/274,805, issued as U.S. Pat. No. 8,998,939 on Apr. 7, 2015,which is incorporated by reference herein. It should be understood thattransducer and blade assembly (102) can freely rotate relative to handleassembly (120) while still maintaining an electrical connection betweenelectrical connector (132) and ring connector (110). In addition, astransducer and blade assembly (102) is inserted into handle assembly(120), a user may rotate transducer and blade assembly (102) and/orinner tubular actuation member (140) to align key (142) with a slot (notshown) of assembly (102). Such an alignment maintains the orientationbetween blade (116) and clamp arm (152) of end effector (150). In someversions, key (142) may be provided on waveguide (114) and/or blade(116) to align inner tubular actuation member (140) with waveguide (114)and/or blade (116). Of course, transducer and blade assembly (102)and/or components thereof may be removably coupled with casing (122) andother components of instrument (101) in numerous other ways as will beapparent to those of ordinary skill in the art in view of the teachingsherein.

With transducer and blade assembly (102) axially restrained withinhandle assembly (120), end effector (150) of the present example is thenattached to outer sheath (138) and inner tubular actuation member (140)as shown in FIG. 3B. It should be understood that instrument (101) iscapable of accommodating various kinds of end effectors (150) as will beapparent to those of ordinary skill in the art in view of the teachingsherein. Outer sheath (138) includes a circumferential groove (134) intowhich a portion of actuation assembly (126) is insertable. It should beunderstood that in some versions end effector (150) is coupled to outersheath (138) and inner tubular actuation member (140) prior to thecoupling of transducer and blade assembly (102). In the present example,opposing L-shaped slots (148) of inner tubular actuation member (140)and outer sheath (138) are aligned such that opposing bayonet pins (154)are insertable into longitudinal portions (143) of each L-shaped slot(148). When bayonet pins (154) reach the proximal end of longitudinalportions (143), the user rotates end effector (150) to rotate bayonetpins (154) into radial portions (144) until bayonet pins reach lockportions (146). With end effector (150) and transducer and bladeassembly (102) coupled to handle assembly (120), the user may then usethe surgical instrument for a procedure. Of course, end effector (150)and/or components thereof may be removably coupled with transducer andblade assembly (102) in numerous other ways as will be apparent to thoseof ordinary skill in the art in view of the teachings herein.

III. Overview of Exemplary Radiofrequency (RF) Surgical Instrument

While some surgical instruments are adapted to use ultrasonic energy tooperate on tissue, other surgical instruments, such as surgicalinstrument (159), shown in FIGS. 3-4, can be configured to supply otherkinds of energy, such as electrical energy and/or heat energy, to thetissue of a patient.

FIGS. 4-5 show an exemplary electrosurgical instrument (159) that isconstructed and operable in accordance with at least some of theteachings of U.S. Pat. Nos. 6,500,176; 7,112,201; 7,125,409; 7,169,146;7,186,253; 7,189,233; 7,220,951; 7,309,849; 7,311,709; 7,354,440;7,381,209; U.S. Pub. No. 2011/0087218, issued as U.S. Pat. No. 8,939,974on Jan. 27, 2015; and/or U.S. patent application Ser. No. 13/151,481,issued as U.S. Pat. No. 9,161,803 on Oct. 20, 2015. As described thereinand as will be described in greater detail below, electrosurgicalinstrument (159) is operable to cut tissue and seal or weld tissue(e.g., a blood vessel, etc.) substantially simultaneously. In otherwords, electrosurgical instrument (159) operates similar to anendocutter type of stapler, except that electrosurgical instrument (159)provides tissue welding through application of bipolar RF energy insteadof providing lines of staples to join tissue. It should also beunderstood that electrosurgical instrument (159) may have variousstructural and functional similarities with the ENSEAL® Tissue SealingDevice by Ethicon Endo-Surgery, Inc., of Cincinnati, Ohio. Furthermore,electrosurgical instrument (159) may have various structural andfunctional similarities with the devices taught in any of the otherreferences that are cited and incorporated by reference herein. To theextent that there is some degree of overlap between the teachings of thereferences cited herein, the ENSEAL® Tissue Sealing Device by EthiconEndo-Surgery, Inc., of Cincinnati, Ohio, and the following teachingsrelating to electrosurgical instrument (159), there is no intent for anyof the description herein to be presumed as admitted prior art. Severalteachings below will in fact go beyond the scope of the teachings of thereferences cited herein and the ENSEAL® Tissue Sealing Device by EthiconEndo-Surgery, Inc., of Cincinnati, Ohio.

A. Exemplary Handpiece and Shaft

Electrosurgical instrument (159) of the present example includes ahandpiece (160), a transmission assembly or shaft (170) extendingdistally from handpiece (160), and an end effector (180) disposed at adistal end of shaft (170). Handpiece (160) of the present exampleincludes a pistol grip (162), a pivoting trigger (164), an activationbutton (166), and an articulation control (168). Trigger (164) ispivotable toward and away from pistol grip (162) to selectively actuateend effector (180) as will be described in greater detail below.Activation button (166) is operable to selectively activate RF circuitrythat is in communication with end effector (180), in a manner describedin U.S. patent application Ser. No. 13/235,660 , issued as U.S. Pat. No.9,402,682 on Aug. 2, 2016, and/or various other references that arecited and incorporated by reference herein. In some versions, activationbutton (166) also serves as a mechanical lockout against trigger (164),such that trigger (164) cannot be fully actuated unless button (166) isbeing pressed simultaneously. Examples of how such a lockout may beprovided are disclosed in one or more of the references cited herein. Itshould be understood that pistol grip (162), trigger (164), and button(166) may be modified, substituted, supplemented, etc. in any suitableway, and that the descriptions of such components herein are merelyillustrative. Articulation control (168) of the present example isoperable to selectively control articulation section (176) of shaft(170) in a manner described in U.S. patent application Ser. No.13/235,660, issued as U.S. Pat. No. 9,402,682 on Aug. 2, 2016, which isincorporated by reference herein.

Shaft (170) of the present example includes an outer sheath (172) and anarticulation section (176). Articulation section (176) is operable toselectively position end effector (180) at various angles relative tothe longitudinal axis defined by sheath (172). Various examples of formsthat articulation section (176) and other components of shaft (170) maytake are described in U.S. patent application Ser. No. 13/235,623,entitled “Control Features for Articulating Surgical Device,” filed Sep.19, 2011, issued as U.S. Pat. No. 9,877,720 on Jan. 30, 2018, thedisclosure of which is incorporated by reference herein. For instance,it should be understood that various components that are operable toactuate articulation section (176) may extend through the interior ofsheath (172). In some versions, shaft (170) is also rotatable about thelongitudinal axis defined by sheath (172), relative to handpiece (160),via a knob (174). Such rotation may provide rotation of end effector(180) and shaft (170) unitarily. In some other versions, knob (174) isoperable to rotate end effector (180) without rotating any portion ofshaft (170) that is proximal of articulation section (176). As anothermerely illustrative example, electrosurgical instrument (159) mayinclude one rotation control that provides rotatability of shaft (170)and end effector (180) as a single unit; and another rotation controlthat provides rotatability of end effector (180) without rotating anyportion of shaft (170) that is proximal of articulation section (176).Other suitable rotation schemes will be apparent to those of ordinaryskill in the art in view of the teachings herein. Of course, rotatablefeatures may simply be omitted if desired.

B. Exemplary End Effector

End effector (180) of the present example comprises a first jaw (182)and a second jaw (184). In the present example, second jaw (184) issubstantially fixed relative to shaft (170); while first jaw (182)pivots relative to shaft (170), toward and away from second jaw (184).In some versions, actuators such as rods or cables, etc., may extendthrough sheath (172) and be joined with first jaw (182) at a pivotalcoupling (183), such that longitudinal movement of the actuatorrods/cables/etc. through shaft (170) provides pivoting of first jaw(182) relative to shaft (170) and relative to second jaw (184). Ofcourse, jaws (182, 184) may instead have any other suitable kind ofmovement and may be actuated in any other suitable fashion. By way ofexample only, and as will be described in greater detail below, jaws(182, 184) may be actuated and thus closed by longitudinal translationof a firing beam (195), such that actuator rods/cables/etc. may simplybe eliminated in some versions.

As best seen in FIGS. 4-5, first jaw (182) defines a longitudinallyextending elongate slot (186); while second jaw (184) also defines alongitudinally extending elongate slot (148). In addition, the top sideof first jaw (182) presents a first electrode surface (190); while theunderside of second jaw (184) presents a second electrode surface (192).Electrode surfaces (190, 192) are in communication with an electricalsource (198) via one or more conductors (not shown) that extend alongthe length of shaft (170). Electrical source (198) is operable todeliver RF energy to first electrode surface (190) at a first polarityand to second electrode surface (192) at a second (opposite) polarity,such that RF current flows between electrode surfaces (190, 192) andthereby through tissue captured between jaws (182, 184). In someversions, firing beam (195) serves as an electrical conductor thatcooperates with electrode surfaces (190, 192) (e.g., as a ground return)for delivery of bipolar RF energy captured between jaws (182, 184).Electrical source (198) may be external to electrosurgical instrument(159) or may be integral with electrosurgical instrument (159) (e.g., inhandpiece (160), etc.), as described in one or more references citedherein or otherwise. A controller (199) regulates delivery of power fromelectrical source (198) to electrode surfaces (190, 192). Controller(199) may also be external to electrosurgical instrument (159) or may beintegral with electrosurgical instrument (159) (e.g., in handpiece(160), etc.), as described in one or more references cited herein orotherwise. It should also be understood that electrode surfaces (190,192) may be provided in a variety of alternative locations,configurations, and relationships.

The lower side of first jaw (182) includes a longitudinally extendingrecess (not shown) adjacent to slot (186); while the upper side ofsecond jaw (184) includes a longitudinally extending recess (not shown)adjacent to slot (188). FIG. 4 shows the upper side of first jaw (182)including a plurality of teeth serrations (194). It should be understoodthat the lower side of second jaw (184) may include complementaryserrations that nest with serrations (194), to enhance gripping oftissue captured between jaws (182, 184) without necessarily tearing thetissue. Serrations (194) may be constructed and operable in accordancewith the teachings of U.S. patent application Ser. No. 13/235,660,issued as U.S. Pat. No. 9,402,682 on Aug. 2, 2016, and/or various otherreferences that are cited and incorporated by reference herein.

With jaws (182, 184) in a closed position, shaft (170) and end effector(180) are sized and configured to fit through trocars having variousinner diameters, such that electrosurgical instrument (159) is usable inminimally invasive surgery, though of course electrosurgical instrument(159) could also be used in open procedures if desired. Shaft (170) andend effector (180) may be constructed and operable in accordance withthe teachings of U.S. patent application Ser. No. 13/235,660, issued asU.S. Pat. No. 9,402,682 on Aug. 2, 2016, and/or various other referencesthat are cited and incorporated by reference herein.

In some versions, end effector (180) includes one or more sensors (notshown) that are configured to sense a variety of parameters at endeffector (180), including but not limited to temperature of adjacenttissue, electrical resistance or impedance of adjacent tissue, voltageacross adjacent tissue, forces exerted on jaws (182, 184) by adjacenttissue, etc. By way of example only, end effector (180) may include oneor more positive temperature coefficient (PTC) thermistor bodies (e.g.,PTC polymer, etc.), located adjacent to electrodes (190, 192) and/orelsewhere. Data from sensors may be communicated to controller (199).Controller (199) may process such data in a variety of ways. By way ofexample only, controller (199) may modulate or otherwise change the RFenergy being delivered to electrode surfaces (190, 192), based at leastin part on data acquired from one or more sensors at end effector (180).In addition or in the alternative, controller (199) may alert the userto one or more conditions via an audio and/or visual feedback device(e.g., speaker, lights, display screen, etc.), based at least in part ondata acquired from one or more sensors at end effector (180). It shouldalso be understood that some kinds of sensors need not necessarily be incommunication with controller (199), and may simply provide a purelylocalized effect at end effector (180). For instance, a PTC thermistorbodies (not shown) at end effector (40) may automatically reduce theenergy delivery at electrode surfaces (190, 192) as the temperature ofthe tissue and/or end effector (180) increases, thereby reducing thelikelihood of overheating. In some such versions, a PTC thermistorelement is in series with power source (198) and electrode surface (190,192); and the PTC thermistor provides an increased impedance (reducingflow of current) in response to temperatures exceeding a threshold.Furthermore, it should be understood that electrode surfaces (190, 192)may be used as sensors (e.g., to sense tissue impedance, etc.). Variouskinds of sensors that may be incorporated into electrosurgicalinstrument (159) will be apparent to those of ordinary skill in the artin view of the teachings herein. Similarly various things that can bedone with data from sensors, by controller (199) or otherwise, will beapparent to those of ordinary skill in the art in view of the teachingsherein. Other suitable variations for end effector (180) will also beapparent to those of ordinary skill in the art in view of the teachingsherein.

C. Exemplary Firing Beam

As also seen in FIGS. 4-5, electrosurgical instrument (159) of thepresent example includes a firing beam (195) that is longitudinallymovable along part of the length of end effector (180). Firing beam(195) is coaxially positioned within shaft (170), extends along thelength of shaft (170), and translates longitudinally within shaft (170)(including articulation section (176) in the present example), though itshould be understood that firing beam (195) and shaft (170) may have anyother suitable relationship. Firing beam (195) includes a sharp distalblade (197), an upper flange (196), and a lower flange (not shown).Firing beam (195) may be constructed and operable in accordance with theteachings of U.S. patent application Ser. No. 13/235,660, issued as U.S.Pat. No. 9,402,682 on Aug. 2, 2016, and/or various other references thatare cited and incorporated by reference herein. Distal blade (197)extends through slots (186, 188) of jaws (182, 184), with upper flange(196) being located above jaw (184) in a recess (not shown) and thelower flange (not shown) being located below jaw (182) in a recess (notshown). The configuration of distal blade (197), upper flange (196), andthe lower flange (not shown) provides an “I-beam” type of cross sectionat the distal end of firing beam (195) and may be constructed andoperable in accordance with the teachings of U.S. patent applicationSer. No. 13/235,660, issued as U.S. Pat. No. 9,402,682 on Aug. 2, 2016,and/or various other references that are cited and incorporated byreference herein.

Distal blade (197) is substantially sharp, such that distal blade willreadily sever tissue that is captured between jaws (182, 184). Distalblade (197) is also electrically grounded in the present example,providing a return path for RF energy as described elsewhere herein. Insome other versions, distal blade (197) serves as an active electrode.In addition or in the alternative, distal blade (197) may be selectivelyenergized with ultrasonic energy (e.g., harmonic vibrations atapproximately 55.5 kHz, etc.).

The “I-beam” type of configuration of firing beam (195) provides closureof jaws (182, 184) as firing beam (195) is advanced distally. Inparticular, flange (196) urges jaw (184) pivotally toward jaw (182) asfiring beam (195) is advanced from a proximal position to a distalposition, by bearing against a recess (not shown) formed in jaw (184).This closing effect on jaws (182, 184) by firing beam (195) may occurbefore distal blade (197) reaches tissue captured between jaws (182,184). Such staging of encounters by firing beam (195) may reduce theforce required to squeeze grip (164) to actuate firing beam (195)through a full firing stroke. In other words, in some such versions,firing beam (195) may have already overcome an initial resistancerequired to substantially close jaws (182, 184) on tissue beforeencountering resistance from the tissue captured between jaws (182,184). Of course, any other suitable staging may be provided.

In the present example, flange (196) is configured to cam against a rampfeature at the proximal end of jaw (184) to open jaw (182) when firingbeam (195) is retracted to a proximal position and to hold jaw (182)open when firing beam (195) remains at the proximal position. Thiscamming capability may facilitate use of end effector (180) to separatelayers of tissue, to perform blunt dissections, etc., by forcing jaws(182, 184) apart from a closed position. In some other versions, jaws(182, 184) are resiliently biased to an open position by a spring orother type of resilient feature. While jaws (182, 184) close or open asfiring beam (195) is translated in the present example, it should beunderstood that other versions may provide independent movement of jaws(182, 184) and firing beam (195). By way of example only, one or morecables, rods, beams, or other features may extend through shaft (170) toselectively actuate jaws (182, 184) independently of firing beam (195).Such jaw (182, 184) actuation features may be separately controlled by adedicated feature of handpiece (160). Alternatively, such jaw actuationfeatures may be controlled by trigger (164) in addition to havingtrigger (164) control firing beam (195). It should also be understoodthat firing beam (195) may be resiliently biased to a proximal position,such that firing beam (195) retracts proximally when a user relaxestheir grip on trigger (164).

D. Exemplary Operation

In an exemplary use, end effector (180) is inserted into a patient via atrocar. Articulation section (176) is substantially straight when endeffector (180) and part of shaft (170) are inserted through the trocar.Articulation control (168) may then be manipulated to pivot or flexarticulation section (176) of shaft (170) in order to position endeffector (180) at a desired position and orientation relative to ananatomical structure within the patient. Two layers of tissue of theanatomical structure are then captured between jaws (182, 184) bysqueezing trigger (164) toward pistol grip (162). Such layers of tissuemay be part of the same natural lumen defining anatomical structure(e.g., blood vessel, portion of gastrointestinal tract, portion ofreproductive system, etc.) in a patient. For instance, one tissue layermay comprise the top portion of a blood vessel while the other tissuelayer may comprise the bottom portion of the blood vessel, along thesame region of length of the blood vessel (e.g., such that the fluidpath through the blood vessel before use of electrosurgical instrument(159) is perpendicular to the longitudinal axis defined by end effector(180), etc.). In other words, the lengths of jaws (182, 184) may beoriented perpendicular to (or at least generally transverse to) thelength of the blood vessel. As noted above, flanges (162, 166) camminglyact to pivot jaw (182) toward jaw (184) when firing beam (195) isactuated distally by squeezing trigger (164) toward pistol grip (162).

With tissue layers captured between jaws (182, 184) firing beam (195)continues to advance distally by the user squeezing trigger (164) towardpistol grip (162). As firing beam (195) advances distally, distal blade(197) simultaneously severs the clamped tissue layers, resulting inseparated upper layer portions being apposed with respective separatedlower layer portions. In some versions, this results in a blood vesselbeing cut in a direction that is generally transverse to the length ofthe blood vessel. It should be understood that the presence of upperflange (162) and the lower flange (not shown) immediately above andbelow jaws (182, 184), respectively, may help keep jaws (182, 184) in aclosed and tightly clamping position. In particular, flanges (162, 166)may help maintain a significantly compressive force between jaws (182,184). With severed tissue layer portions being compressed between jaws(182, 184), electrode surfaces (190, 192) are activated with bipolar RFenergy by the user depressing activation button (166). In some versions,electrodes (190, 192) are selectively coupled with power source (198)(e.g., by the user depressing button (166), etc.) such that electrodesurfaces (190, 192) of jaws (182, 184) are activated with a common firstpolarity while firing beam (195) is activated at a second polarity thatis opposite to the first polarity. Thus, a bipolar RF current flowsbetween firing beam (195) and electrode surfaces (190, 192) of jaws(182, 184), through the compressed regions of severed tissue layerportions. In some other versions, electrode surface (190) has onepolarity while electrode surface (192) and firing beam (195) both havethe other polarity. In either version (among at least some others),bipolar RF energy delivered by power source (198) ultimately thermallywelds the tissue layer portions on one side of firing beam (195)together and the tissue layer portions on the other side of firing beam(195) together.

In certain circumstances, the heat generated by activated electrodesurfaces (190, 192) can denature the collagen within the tissue layerportions and, in cooperation with clamping pressure provided by jaws(182, 184), the denatured collagen can form a seal within the tissuelayer portions. Thus, the severed ends of the natural lumen defininganatomical structure are hemostatically sealed shut, such that thesevered ends will not leak bodily fluids. In some versions, electrodesurfaces (190, 192) may be activated with bipolar RF energy beforefiring beam (195) even begins to translate distally and thus before thetissue is even severed. For instance, such timing may be provided inversions where button (166) serves as a mechanical lockout relative totrigger (164) in addition to serving as a switch between power source(198) and electrode surfaces (190, 192).

While several of the teachings below are described as variations ofinstruments (10, 50, 101, 159), it should be understood that variousteachings below may also be incorporated into various other types ofdevices. By way of example only, in addition to being readilyincorporated into instruments (10, 50, 101, 159), various teachingsbelow may be readily incorporated into the devices taught in any of thereferences cited herein, surgical staplers, surgical clip appliers, andtissue graspers, among various other devices. Other suitable devicesinto which the following teachings may be incorporated will be apparentto those of ordinary skill in the art in view of the teachings herein.Of course end effectors (16, 80, 150, 180) and surgical instruments (10,50, 101, 159) may also include other configurations as will be apparentto one of ordinary skill in the art in view of the teachings herein.

IV. Exemplary Coupling Mechanisms for Modular Shafts and End Effectors

In some instances it may be useful to change between various shaftlengths and/or types of end effectors (16, 80, 150, 180) while using thesame handle assembly (60, 120, 160). For instance, in some procedures, alarge amount of tissue may need to be cut, requiring different lengthend effectors (80, 150, 180) and/or shafts for transmission assemblies(70, 102, 170). Such interchangeable shafts and/or end effectors (80,150, 180) may permit a common handle assembly (60, 120, 160) to be usedfor various surgical procedures (e.g., short shafts for open surgery,long shafts for minimally invasive laparoscopic surgery, etc.).Moreover, changing out the shafts and/or the end effectors (80, 150,180) while reusing the same handle assembly (60, 120, 160) may be moretime and/or cost effective than using a new surgical instrument (50,101, 159) with the different length shaft. By way of example only, suchshafts and/or end effectors (80, 150, 180) may include color codes todistinguish the various lengths and/or types. In another instance, thehandle assembly (60, 120, 160) may be configured to employ differenttypes of end effectors, for instance, the handle assembly (60, 120, 160)may include components to operate an ultrasonic end effector (80, 150)and/or an RF end effector (180). Thus, changing the shafts and endeffectors (80, 150, 180) with a common handle assembly (60, 120, 160)may conserve time and/or costs. Accordingly, various coupling mechanismsfor coupling the modular shafts to the handle assemblies (60, 120, 160)are described below. It should be understood that in versions where anultrasonic end effector (80) is used, at least part of transducer (100)may be integral with the shaft and end effector (80), and may thus beselectively coupled with handle assembly (60). Alternatively, transducer(100) may be integral with handle assembly (60) such that the shaft andend effector (80) are selectively coupled with transducer (100) when theshaft and end effector (80) are selectively coupled with handle assembly(60).

An exemplary coupling mechanism (200) comprises a threaded slip nut(230) disposed about a shaft (220) of an exemplary end effector assembly(210), shown in FIGS. 6A-6B. In the present example, end effectorassembly (210) comprises a transmission assembly (212), a rotation knob(214), and a shaft (220) extending proximally relative to rotation knob(214). It should be understood that rotation knob (214) is merelyoptional and may be omitted. Rotation knob (214) is operable to rotatetransmission assembly (212) relative to a handle assembly (240) and/orshaft (220). An end effector (not shown) is coupled to a distal end oftransmission assembly (212). The end effector may include an ultrasonicend effector (80, 150), an RF end effector (180), and/or any other endeffector or combination of end effectors as will be apparent to one ofordinary skill in the art in view of the teachings herein. Transmissionassembly (212) is operable to communicate energy (e.g., ultrasonicvibrations, RF energy, and/or mechanical motion/force, etc.) from asource proximal to transmission assembly (212) to an end effector at thedistal end of transmission assembly (212). In the instance of anultrasonic end effector, such as end effector (80), an axial bore (notshown) through shaft (220) may permit mechanical coupling oftransmission assembly (212) through shaft (220) to components withinhandle assembly (240), which may be configured in a similar manner tomulti-piece handle assembly (60) described above. In the case of an RFend effector, such as end effector (180), the axial bore may permit aportion of transmission assembly (212) to extend at least partiallythrough shaft (220). Transmission assembly (212) may include an innerslip ring connector that is electrically coupleable to a complementaryslip ring connector on the interior of shaft (220) such that anelectrical coupling from handle assembly (240) may be made to the endeffector. In yet another alternative, a fluid coupling may also be madevia the bore through shaft (220) and/or elsewhere on end effectorassembly (210).

In the present example, a threaded slip nut (230) is slidably disposedabout shaft (220). Threaded slip nut (230) includes a keyway (232)(shown in phantom) at a proximal end of threaded slip nut (230). Itshould be understood that keyway (232) may alternatively be located on adistal end of threaded slip nut (230). Keyway (232) of the presentexample only partially extends through threaded slip nut (230), thoughkeyway (232) may alternatively extend completely through threaded slipnut (230). As shown in FIGS. 6A-6B, keyway (232) is configured toreceive a keyed portion (222) of shaft (220). In the present example,keyed portion (222) of shaft (220) is located near a proximal end ofshaft (220) and extends outwardly from shaft (220), though it should beunderstood that keyed portion (222) may alternatively be locateddistally near rotation knob (214) or at a midpoint of shaft (220). Inone merely alternative example, keyed portion (222) may be slidablerelative to shaft (220), such as by actuation of a slider to slide keyedportion (222) into keyway (232). Shaft (220) further comprises aproximal flange (224) located on the proximal end of shaft (220) andsized to prevent threaded slip nut (230) from sliding proximally off ofshaft (220). As will be described below, keyed portion (222) isinsertable into keyway (232) when a user desires to thread threaded slipnut (230) into internal threading (250) of handle assembly (240).Threaded slip nut (230) of the present example may then be slid distallyon shaft (220) to disengage keyed portion (222) from keyway (232),thereby permitting shaft (220), rotation knob (214), and/or transmissionassembly (212) to rotate freely relative to threaded slip nut (230)and/or handle assembly (240).

In some instance threaded slip nut (230) may be slidably disposed on aninner tube, such as an inner tubular actuating member described above.In such a configuration, threaded slip nut (230) may be configured tothread into a yoke, such as trigger yoke (185) described in U.S. Pat.Pub. No. 2011/0015660, entitled “Rotating Transducer Mount forUltrasonic Surgical Instruments,” published Jan. 20, 2011, issued asU.S. Pat. No. 8,461,744 on Jun. 11, 2013, the disclosure of which isincorporated by reference herein. A blade, such as blade (82) describedabove, may be coupled to a transducer, such as transducer (100)described above. The inner tubular actuating member may be actuated viathe coupling of threaded slip nut (230) to the yoke. Accordingly, aclamp arm, such as clamp arm (84) described above, may be operable toclamp tissue against the blade.

In the present example, handle assembly (240) is shown having a distalaperture (242) formed within a casing (244) and configured to receiveshaft (220) and threaded slip nut (230) of end effector assembly (210).Handle assembly (240) may further be configured in accordance with atleast some of the teachings for multi-piece handle assembly (60), forhandle assembly (152), of U.S. Pat. Pub. No. 2011/0015660, entitled“Rotating Transducer Mount for Ultrasonic Surgical Instruments,”published Jan. 20, 2011, issued as U.S. Pat. No. 8,461,744 on Jun. 11,2013, or of U.S. Pat. No. 6,500,176, entitled “Electrosurgical Systemsand Techniques for Sealing Tissue,” issued Dec. 31, 2002, thedisclosures of which are incorporated by reference herein, and/or in anyother suitable fashion. In the present example, handle assembly (240)includes a member (248) having internal threading (250) disposed about amember aperture (252). Internal threading (250) and threaded slip nut(230) are configured to thread together to secure end effector assembly(210) to handle assembly (240).

As shown in the sequence of FIGS. 6A-6B, threaded slip nut (230) of thepresent example is slid proximally such that keyed portion (222) ofshaft (220) engages keyway (232) of threaded slip nut (230). With therotational freedom of threaded slip nut (230) restricted by theengagement of keyed portion (222) and keyway (232), a user then threadsthreaded slip nut (230) into internal threading (250) of handle assembly(240). For instance, an L-shaped spacer tool may be used to urgethreaded slip nut (230) proximally on shaft (220) against flange (224)while the user threads threaded slip nut (230) into internal threading(250). Alternatively, a user may manually urge threaded slip nut (230)proximally. Further still, a slider, as noted above, may engage aportion of threaded slip nut (230) to urge threaded slip nut (230)proximally. Of course, still other methods of urging threaded slip nut(230) proximally to engage keyed portion (222) and keyway (232) will beapparent to those of ordinary skill in the art in view of the teachingsherein. For instance, a spring (not shown) may be disposed about shaft(220) distally of slip nut (230) and proximally of rotation knob (214),thereby biasing slip nut (230) proximally such that keyway (232) isengaged with keyed portion (222). When the user desires to rotate endeffector assembly (210), the user grasps rotation knob (214) and pushesend effector assembly (210) proximally until keyed portion (222)disengages from keyway (232).

Once threaded slip nut (230) has been sufficiently threaded intointernal threading (250) (for instance, a torque limiting tool may beused), end effector assembly (210) is slid proximally to disengage keyedportion (222) from keyway (232). End effector assembly (210) may bemanually slid distally or, in one alternative, a spring (not shown)located between flange (224) and threaded slip nut (230) may urge endeffector assembly (210) distally. In the instance of an ultrasonicinstrument, shaft (220) of end effector assembly (210) may be threadedonto a horn of a transducer, such as transducer (100) described above.Such threading may occur prior to, contemporaneously with, or after thethreading of threaded slip nut (230) into internal threading (250).Alternatively, in the instance of an RF instrument, shaft (220) may becoupled to one or more electrical connectors (not shown) to couple theend effector to a power source. As shown in FIG. 6B, end effectorassembly (210) is effectively longitudinally secured to handle assembly(240) while permitting rotational movement of shaft (220), rotation knob(214), and/or transmission assembly (212). A user may then use theassembled surgical instrument for a procedure. When the user desires todecouple end effector assembly (210) from handle assembly (240), theuser pulls end effector assembly (210) distally until keyed portion(222) of shaft (220) engages keyway (232) of threaded slip nut (230).Alternatively, the L-shaped spacer tool may be wedged between threadedslip nut (230) and rotation knob (214) to urge threaded slip nut (230)proximally. With keyed portion (222) and keyway (232) engaged, the usermay then unscrew threaded slip nut (230) from internal threading (250),thereby decoupling end effector assembly (210) from handle assembly(240). A user may then couple a new end effector assembly (210) tohandle assembly (240).

Of course other configurations for coupling mechanism (200) will beapparent to one of ordinary skill in the art in view of the teachingsherein. For instance, threaded slip nut (230) may be located betweenflange (224) and another annular flange (not shown) of shaft (220). Inthis example, keyed portion (222) may be actuated radially outward froman initial position within a recess (not shown) of shaft (220) to aposition where keyed portion (222) engages keyway (232) of threaded slipnut (230). For instance, keyed portion (222) may be actuated by a cammember coupled to a slider located on transmission assembly (212) and/orrotation knob (214). As will become apparent from the previous and laterdisclosures herein, various other electrical and/or mechanical couplingmechanisms and/or features may be used to substitute coupling mechanism(200), to modify coupling mechanism (200), or to combine with couplingmechanism (200).

V. Exemplary Information Transmission System

FIG. 7 shows a schematic view of an information transmission system(300) using device (10) to transmit information. It should be understoodthat various kinds of devices or instruments (10, 24, 101, 159) may beused in system (300) alongside removable end effectors (16, 80, 150,180), respective transmission assemblies (70, 102, 170), and reusablehandle assemblies (60, 120, 160) where it may be useful to changebetween various shaft lengths and/or types, as described above. Device(10) is shown as connected to generator (28), as described above, thoughgenerator (28) may be incorporated into device (10) or omitted in someversions. Sensor (20) in device (10), which may be included in any ofinstruments (24, 101, 159), may gather information regarding use ofdevice (10) during a surgical procedure on a patient. Such informationmay be transmitted to generator (28), which then transmits theinformation via a secure gateway (302) to a secure server (304). Gateway(302) of the present example includes Secure Web Gateway (SWG)technology combining features such as anti-malware, URL filtering, webcontent filtering, bandwidth management, application control, and/orcaching capabilities in order to secure, monitor, and control trafficbetween generator (28) and server (304), regardless of whether suchtraffic is encrypted or not. Server (304), which may be a secure serveroutside a hospital network, communicates the information via a secureweb interface (306) to a unique patient file (308). Patient file (308)includes patient history specific to the first patient on whom device(10) was used during the surgical procedure from which information wascollected and transmitted. The particular device (10) and componentsused on the first patient may be, for example, tracked and entered intopatient file (308) via the system shown in FIG. 7. Information may beshared to patient file (308) directly after use of device (10) in theassociated surgical procedure performed on the first patient. To theextent that a hospital desires to track patient care throughout anentire experience associated with a patient, including but not limitedinformation such as the types of tools, services, and materials thatwere used on or for a patient during that patient's hospital experience,system (300) assists with this goal by providing desired informationregarding device (10) used with a patient during a particular surgicalprocedure. By tracking information such as amount of time a device suchas device (10) and its attached and/or removable components were used ona patient along with electrical characteristics associated with suchuse, and the types of device and/or device components used, a cost maybe calculated based on the tracked information. Further, by trackingsuch information and data monitoring, analysis and recommendations forfuture surgical improvements may be obtained from the tracked proceduredata to improve outcomes of and to build best practices for similarfuture surgeries. Hospitals using system (300) may control what type ofdata tracked during use of device (10) is associated with a specificpatient that device (10) was used upon during a surgical procedure, andthus which data is viewable in patient file (308). System (300)transmits information via a secure process as described below.

FIGS. 8A-8B show an exemplary process that may be carried out usingsystem (300). Unique serial numbers may be associated with particulartypes of instruments (10, 24, 101, 159) and/or medical devicecomponents, such as removable end effectors (16, 80, 150, 180), andrespective transmission assemblies (70, 102, 170), and handle assemblies(60, 120, 160). Each unique serial number of device (10), for example,and components associated with device (10), is received (500) bygenerator (28). For example, such data may be transmitted to andreceived by generator (28) via a wired or wireless connection, may bemanually inputted into a user interface in communication with generator(28), and/or may be automatically registered by generator (28) via areceiver in communication with generator (28). For ease of reference,regarding use with system (300), when device (10) is referencedalongside its components, it is understood that any of devices orinstruments (10, 24, 101, 159) alongside respective removable endeffectors (16, 80, 150, 180), and respective transmission assemblies(70, 102, 170), and respective handle assemblies (60, 120, 160) may beused in place of device (10) and its components. Additionally oralternatively, generator (28) may be removed from system (300) andinformation from sensor (20) of device (10), or other instruments suchas instrument (159), for example, may be transmitted wirelessly and/orvia a wired communication to secure gateway (302).

Information such as the type of device (10) and type of end effector(16) used, or that of any of the instruments, end effectors,transmission assemblies, and/or handle assemblies within the presentdisclosure, and the amount of time such components were used during asurgical procedure on a patient are transmitted via system (300) toserver (304). System (300) may also transmit information indicating thetype of surgical procedure to server (304). Other suitable types ofinformation that may be transmitted to server (304) will be apparent toone of ordinary skill in the art in view of the teachings herein. Asshown in FIG. 8, unique serial numbers of medical device components usedor to be used in a surgical procedure, are received (500) in generator(28). A security or secure key is or has been coded (502) into securegateway (302). The medical device components are then used on a firstpatient during a surgical procedure. Data is captured (504) in device(10), for example, during the surgical procedure on the first patientvia sensor (20) in device (10). As described above, such data mayinclude a sensed temperature at end effector (16), a determinedoscillation rate of end effector (16), the impedance of tissueencountered by end effector (16) and/or other properties of such tissue,motions of end effector (16) during a surgical procedure (e.g., whensensor (20) includes an accelerometer), and/or other data as will beapparent to one of ordinary skill in the art in view of the teachingsherein. Information including the captured data and the unique serialnumbers associated with the used device (10) and end effector (16), forexample, is transmitted (506) to generator (28). Generator (28) may beconnected via, for example, a USB port, ethernet, or other wired orwireless connection to secure gateway (302) in a one-way or two-wayconnection. The gathered information is thereby uploaded (508) to securegateway (302) via generator (28). It should be understood that any stepwithin steps (500-508) may be performed at any suitable time. Forinstance, step (508) may be carried out through a continuous data streamthroughout the surgical procedure. Alternatively, step (508) may becarried out after the procedure is complete. Other time frames andrelationships will be apparent to one of ordinary skill in the art inview of the teachings herein.

As shown in FIG. 8B, after the surgical procedure is compete, a call isinitiated (510) to secure server (304) to request the previously codedsecure key. Server (304) replies (512) to the call request with thepreviously coded secure key. The secure key is validated (514) viasecure gateway (302) after being received. Upon successful completion ofthe secure key validation, an upload of information to secure server(304) is initiated (516) via secure gateway (302). The uploadedinformation is transmitted (518) via secure server (304) to patient file(308) associated with the first patient that underwent the surgicalprocedure using device (10) and end effector (16). In some instances acost is determined (520) based on the transmitted, uploaded informationin patient file (308), amount of time used and data regarding use ofdevice (10) and end effector (16), and other device components, and/orother information. For instance, a dollar amount may be associated withminutes of use for device (10), for an amount of voltage used via aconnection between generator (28) and device (10) for application ontissue of the first patient during the surgical procedure, total energyused by device (10), total current used by device (10), number ofactivations of device (10), and/or various other parameters, includingvarious combinations of parameters. The retrieved information may betallied and a pre-set calculation may be applied to the retrievedinformation to generate an overall cost of use associated with device(10) during the surgical procedure on the first patient. The talliedcost may be stored in patient file (308) and displayed on, for example,a computer monitor or other user information or printed on one or morereports generated from patient file (308). A hospital may track costsassociated across various patients with devices and/or components havingcertain serial numbers to analyze results and view which types ofdevices and/or components may be more costly than others or might bedesirably used in certain types of surgeries in a cost-effective andtime-effective manner.

The tallied cost may also be submitted to an outside server (304) as aninvoice that the hospital might pay to one or more vendors ormanufacturers of device (10), end effector (16), and/or other componentsof device (10). Server (304) also may play the function of notifying ahospital information technology system that new data has been loggedinto a patient file (308) along with information regarding the time ofreceipt of the logged information and other suitable information asapparent to one of ordinary skill in the art in view of the teachingsherein. Of course, the instrument usage data need not necessarily beused for establishing usage costs or controls. For instance, usage datamay be used as a measure of surgical time, surgeon/operator performance,efficiency, effectiveness, etc. Other suitable ways in which instrumentusage data might be used will be apparent to one of ordinary skill inthe art in view of the teachings herein.

VI. Exemplary Sensor to Track Instrument Usage Characteristics

FIGS. 9-12 show graphical views of sample instrument usagecharacteristics trackable on device (10) during a surgical procedure ona patient, for example, via sensor (20) of device (10). Sensor (20) inan example may track a technique that a surgeon uses on device (10)during the procedure. Feedback from sensor (20), for example, may betransmitted via a wired or wireless connection to a receiving devicesuch as server (304) or other suitable device, such as a computer orsmartphone. Software programs can then be used to analyze thetransmitted data for use by the surgeon, the Operation Room (“OR”)staff, biomedical researchers, or others, such as in a manner asdescribed in accordance with the teachings of U.S. patent applicationSer. No. 13/276,725, issued as U.S. Pat. No. 9,095,346 on Aug. 4, 2015,the disclosure of which is incorporated by reference herein.

Sensor (20) may comprise, for example, a piezoelectric accelerometer, agyroscope, a pressure sensor, a force transducer, and/or other suitabletype of sensor as apparent to one of ordinary skill in the art in viewof the teachings herein. It should be understood that device (10) mayinclude more than one type of integral sensor (20). Sensor (20) may beoperable in accordance with the teachings of U.S. patent applicationSer. No. 13/276,660, issued as U.S. Pat. No. 9,364,279 on Jun. 14, 2016,the disclosure of which is incorporated herein. For example, a pressuresensor may be built into trigger (18) of device (10). The pressuresensor may comprise an electronic pressure sensor, or pressuretransducer, converting pressure into an analog electrical signal. Suchpressure transducers may utilize force collectors such as a diaphragm tomeasure strain or deflection due to an applied force over a space. Forcecollector types may include but not be limited to a piezoresistivestrain gauge, capacitive strain gauge, electromagnetic strain gauge,piezoelectric strain gauge, and/or optical strain gauge. Varioussuitable forms that such gauges may take will be apparent to those ofordinary skill in the art in view of the teachings herein. Similarly,various suitable ways in which such strain gauges may be incorporatedinto trigger (18) will be apparent to those of ordinary skill in the artin view of the teachings herein.

Sensor (20) may be disposed in any of instruments (10, 24, 101, 159) andin various locations within instruments (10, 24, 101, 159), such as inremovable end effectors (16, 80, 150, 180), and/or respectivetransmission assemblies (70, 102, 170), and/or handle assemblies (60,120, 160). Removable end effectors (16, 80, 150, 180), and/or respectivetransmission assemblies (70, 102, 170), attachable to handle assemblies(60, 120, 160) are referable to as “Apps” in the present disclosure.Sensor (20) may be disposed in, for example, a removable App that isattachable to a handle portion of device (10).

It should be understood that sensor (20) may take a variety ofadditional or alternative forms. For instance, sensor (20) may beoperable to measure the acoustic impedance of device (10). In additionor in the alternative, sensor (20) may be operable to measure electricalimpedance of tissue. Furthermore, sensor (20) may comprise adisplacement measuring device giving feedback on a position of a clamparm of end effector (16) (e.g., indicating whether the clamp arm is inan open position, closed position, or somewhere between). Sensor (20)may also comprise one or more thermal sensors disposed within the clamparm of the end effector to register a clamp arm temperature and/or atissue temperature. Sensor (20) may also comprise a pressure sensordisposed in the clamp arm of end effector (16) to measure the pressureapplied to tissue by the clamp arm and an opposing blade of end effector(16). Sensor (20) may additionally be a combination of two or more ofthe above-described sensors. For example, one or more sensors (20) maybe operable to provide information regarding both clamp force as well asclamp arm position. Other suitable forms that sensor (20) may take willbe apparent to those of ordinary skill in the art in view of theteachings herein.

After device (10) is used in a procedure and/or during use of device(10) in a procedure, for example, information may be transmitted via awireless or wired communication to generator (28), to a smartphone,and/or to a computer, as described above. If transmitted via a wiredconnection, the connection may stem from the used App, the handleportion of device (10), and/or generator (28) attached to device (10).Transmitted information may be uploaded to server (304) and be used ininformation transmission system (300) as described above. In addition toinformation gathered by sensor (20), such transmitted information mayinclude information from generator (28) relating to generator (28)operating parameters during the surgical procedure, information relatingto the type of surgical procedure (e.g., manually inputted by a user),and/or any other type of information as will be apparent to one ofordinary skill in the art in view of the teachings herein. Uploadedinformation may be viewable on a user interface on a computer, forexample, and may be used for data analysis (such as analysis ofelectrical characteristics received from generator (28) after a surgicalprocedure). FIGS. 9-12 show examples of data and information on a userinterface that users may review and analyze after transmission of suchinformation as described above.

FIG. 9 shows a view of data retrieved from sensor (20) in a used Appand/or handle portion of device (10), for example. The data in thisexample includes information regarding steadiness (530), speed (532),and blade pressure (534) mapped out over an x-value of time in seconds.The left side y-value shows units of microns of movement per second,indicating steadiness (530) of device (10); and the right side y-valueshows units of pounds of force, indicating blade pressure (534). Asshown in FIG. 9, over the time device (10) was used in a sample surgicalprocedure, the surgeon using device (10) used a fairly constant speed(532) with device (10), applied about two cycles of built up and reducedpressure (534) on end effector (16) of device (10) against theoperated-upon tissue, and has a steadiness (530) that fairly paralleledthe blade pressure (534) applied against the tissue, with steadiness(530) building when pressure (534) built and dropping when pressure(534) dropped. Such data may be interpreted to indicate that, as bladepressure (534) increases, the ability to maintain steadiness (530) ofdevice (10) decreases.

FIG. 10 shows a view of electrical characteristics data retrieved fromgenerator (28) after a surgical procedure, for example, via sensor (20)and/or generator (28). The x-value on the graphs measures time inminutes. The left side y-value measures both power (540) measured inWatts (W) and voltage (542) measured in Volts (V), and the right sidey-value measures tissue impedance (548) in units of Ohms (Ω). Impedancecorrelates to an amount of resistance to current in tissue (such that anincreased impedance reduces the flow of current). For instance, sensor(20) may be used to sense tissue impedance. The application of trigger(18) of device (10) is shown by line (544) at a first time around 30seconds into the procedure. The transection of operated upon tissue viaend effector (16), for example, is shown by line (546) about 9 minutesinto the procedure. FIGS. 11-12 also depict graphs indicating anapplication of trigger (18), shown via line (544), and a transection ofoperated upon tissue by end effector (16), shown via line (546).

Power (540), voltage (542), and impedance (548) are fairly consistent inthe terms of use as each appears to respectively rise and fall inrespective measured units alongside similar increases and decreases ofunit measurements the other electrical characteristics. For example, aspower increases, voltage tends to increase, and impedance tends toincrease at relatively similar rates. Thus, when an increased voltage(542) is being applied to device (10) from, for example, generator (28),FIG. 10 appears to indicate that a corresponding increase in impedance(548) reduces the flow of current to the operated upon tissue. Such datamight be interpreted to indicate why tissue transaction times might beslower in certain settings. Such data could further be interpretedindicate the type of tissue being transected.

FIG. 11 shows a view of other electrical characteristics data retrievedfrom generator (28) after a surgical procedure, for example, via sensor(20) and/or generator (28). In particular, FIG. 11 analyses thefrequency slope and current characteristics retrieved from generator(28). The x-value on the graphs measures time in seconds. The left sidey-value depicts frequency slope (550) measured in Hertz per Second(Hz/s), and the right side y-value measures current (552) measured inmilli-Amps (mA). Line (544) shows that trigger (18) of device (10), forexample, was applied at about some seconds past a 2 minute mark on thegraph and the transection to the operated upon tissue by end effector(16) occurred at about just past the 4 minute mark. Generally, whentrigger (18) was applied, current (552) dropped. Between lines (544,546), when current (552) dropped or decreased, frequency slope (550)tended to rise or increase, and when current (552) increased, frequencyslope (550) tended to decrease.

FIG. 12 shows a view of other electrical characteristics data retrievedfrom generator (28) after a surgical procedure, for example, via sensor(20) and/or generator (28). In particular, FIG. 12 analyses thefrequency characteristics retrieved from generator (28). The x-value onthe graphs measures time in seconds. The left side y-value depictsfrequency (560) measured in Hertz (Hz). Similar to FIG. 11, line (544)shows that trigger (18) of device (10), for example, was applied atabout some seconds past a 2 minute mark on the graph and the transectionto the operated upon tissue by end effector (16) occurred at about justpast the 4 minute mark. Generally, between the time trigger (18) wasapplied and the transaction occurred via device (10), frequency (560)dropped.

The graphs may assist a user with reviewing and analysis of the dataassociated with a specific surgery on a specific patient. Through a webinterface or other type of graphical user interface, a user may marksuch data with note, such as how tired a surgeon felt on a particularday for example, or the number of assistants in the room for theparticular, tracked surgery, as well as the equipment available for thesurgical procedure. By way of example only, a user may annotate graphsin accordance with at least some of the teachings of U.S. Patent Appl.Publ. No. 2011/0172687, entitled “Telemetry Device with Software UserInput Features,” published Jul. 14, 2011, issued as U.S. Pat. No.8,852,118 on Oct. 7, 2014, the disclosure of which is incorporated byreference herein. A software application tool may be utilized to furtherexport and analysis the data to determine, for example, what the sourceof a user's habits might be, and/or whether a user tends to move a bladeof an end effector, such as end effector (16), around more than desiredwhen transecting a high-risk area (e.g., an area surrounded withsubstantially small blood vessels). By way of example only, the data mayalso be used to determine if the surgeon's diet, exercise, mental state,and/or other conditions affect the surgeon's steadiness or overalltiming of a surgical procedure (or segment of a surgical procedure).Other suitable ways in which the above-described types of data may beused will be apparent to one of ordinary skill in the art in view of theteachings herein.

VII. Exemplary Calibration Kit

FIGS. 13A-13B depict a process of using a calibration kit to set andstore outcome settings which may be applied to at least one selected Appfor a device (10), for example, during a procedure. This process may beused to learn and account for unique usage idiosyncrasies for eachsurgeon, such as abnormal surgical techniques/tendencies, to promoteconsistent surgical results. Desired datable end effectors and/or shaftassemblies, described above as Apps, are selected (600) by a user.Additionally, a calibration kit is setup (602). The calibration kit mayinclude, for example, synthetic tissue models having known parametersand characteristics, tissue such as pork belly or other suitabletestable organic and/or synthetic tissue, sample vessels from suitabletestable sources (such as, for example, a pig), and other suitabletestable parts from a testable source, as well as other suitabletestable materials that may be organic and/or synthetic. The calibrationkit includes various materials that assist to gather data to test asurgeon's usage behavior and preferences with a device (10), forexample, on the test material before testing the usage on a patientduring a surgical procedure. Certain various parameters may be trackedand calibrated, such as a preferred force the surgeon desires to apply,average speeds the surgeon tends to use, and/or other parameters as willbe apparent to one of ordinary skill in the art in view of the teachingsherein. In the present example, generator (28) provides selectionbetween a calibration mode and at least one surgical procedure mode.

FIG. 13A shows that a calibration mode including such parameters totrack, for example, is entered (604) on generator (28). Each of theselected Apps are used (606) with the calibration kit by the surgeon toestablish the surgeon's personally calibrated parameter settings. Forexample, a surgeon uses a selected App on organic pig tissue that may beincluded in the calibration kit, utilizing the App with device (10) tocut, transect, and seal the pig tissue and internal vessels and retrieveusage data from the test procedure on the pig tissue. For instance, theuser may delete data associated with unsuccessful testing on thetissue/model provided in the kit, saving only data associated withsuccessful testing. In addition or in the alternative, generator (28)can automatically adjust its own operating parameters during thecalibration process in an attempt to achieve surgical success in thetesting despite any abnormal surgical techniques/tendencies displayed bythe surgeon. The desired outcome centered on these parameters areobtained (608) via use of the calibration kit as well as a set ofassociated outcome settings or parameters. The obtained outcome settings(610) are stored in generator (28) and are associated with a user key.The obtained outcome settings (610) may also include data gathered inaccordance with other teachings herein (e.g., from sensor (20)). Basedon data collected during the calibration procedure shown in FIG. 13A,generator (28) is able to establish compensatory operating parameters tocompensate for surgeon tendencies. For instance, if the calibrationprocess shows that the surgeon tends to apply an abnormally high amountof force to tissue, generator (28) may know to reduce power to avoidunintended/adverse tissue damage. Other ways in which operatingparameters of generator (28) may be adjusted based on surgeon usageidiosyncrasies will be apparent to one of ordinary skill in the art inview of the teachings herein.

FIG. 13B shows steps that may be carried out after generator (28) hasbeen calibrated based on the particular surgeon's unique usageidiosyncrasies. In particular, FIG. 13B shows that at least one App isselected (612) for use in a surgical procedure by, for example, thesurgeon. The selected App is connected (614) to the generator (28). Theuser key is entered (616) into a user interface that is in communicationwith generator (28), such that the calibrated settings are recalled(618) via the entry of the user key. The calibrated settings aretransmitted (620) to the selected App, which is used (622) in a surgicalprocedure.

For the foregoing examples, it should be understood that the handleassemblies and/or end effectors may be reusable, autoclavable, and/ordisposable. For instance, the foregoing end effectors may be disposablewhile the handle assemblies are reuseable and/or autoclavable. Inaddition, if internal power sources are used with the foregoing handleassemblies, the internal power sources may be rechargeable. Forinstance, the handle assemblies may be recharged using a plug inrecharge, by removing and recharging the batteries, by induction, and/orby any other method as will be apparent to one of ordinary skill in theart in view of the teachings herein. Furthermore, alignment features orguides may be included to aid in the alignment and coupling of the endeffectors with handle assemblies. Such guides may help prevent damage tothe end effector and/or handle assembly during the assembly of thesurgical instrument.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Embodiments of the present invention have application in conventionalendoscopic and open surgical instrumentation as well as application inrobotic-assisted surgery. For instance, those of ordinary skill in theart will recognize that various teaching herein may be readily combinedwith various teachings of U.S. Pat. No. 6,783,524, entitled “RoboticSurgical Tool with Ultrasound Cauterizing and Cutting Instrument,”issued Aug. 31, 2004, the disclosure of which is incorporated byreference herein.

By way of example only, embodiments described herein may be processedbefore surgery. First, a new or used instrument may be obtained and ifnecessary cleaned. The instrument may then be sterilized. In onesterilization technique, the instrument is placed in a closed and sealedcontainer, such as a plastic or TYVEK bag. The container and instrumentmay then be placed in a field of radiation that can penetrate thecontainer, such as gamma radiation, x-rays, or high-energy electrons.The radiation may kill bacteria on the instrument and in the container.The sterilized instrument may then be stored in the sterile container.The sealed container may keep the instrument sterile until it is openedin a medical facility. A device may also be sterilized using any othertechnique known in the art, including but not limited to beta or gammaradiation, ethylene oxide, or steam.

Embodiments of the devices disclosed herein can be reconditioned forreuse after at least one use. Reconditioning may include any combinationof the steps of disassembly of the device, followed by cleaning orreplacement of particular pieces, and subsequent reassembly. Inparticular, embodiments of the devices disclosed herein may bedisassembled, and any number of the particular pieces or parts of thedevices may be selectively replaced or removed in any combination. Uponcleaning and/or replacement of particular parts, embodiments of thedevices may be reassembled for subsequent use either at a reconditioningfacility, or by a surgical team immediately prior to a surgicalprocedure. Those skilled in the art will appreciate that reconditioningof a device may utilize a variety of techniques for disassembly,cleaning/replacement, and reassembly. Use of such techniques, and theresulting reconditioned device, are all within the scope of the presentapplication.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

We claim:
 1. A method for uploading information from a generator incommunication with a surgical instrument, the surgical instrumentincluding a detachable transmission assembly extending distally from abody, wherein an end effector is disposed at a distal end of thetransmission assembly, wherein the method comprises the steps of: (a)capturing a set of performance data via a sensor disposed in at leastone of the detachable transmission assembly, the end effector, or thebody of the surgical instrument, wherein the act of capturing the set ofperformance data via the sensor is performed while the surgicalinstrument is used in a medical procedure on a first patient; (b)storing one or more unique identifiers associated with at least one ofthe detachable transmission assembly, the end effector, or the body ofthe surgical instrument; (c) capturing a set of generator data while theset of performance data is captured; (d) creating a set of component usedata based upon the set of performance data, the one or more uniqueidentifiers, and the set of generator data; (e) uploading the set ofcomponent use data, via a processor, to a server; and (f) associatingthe set of component use data with a patient file of the first patient.2. The method of claim 1, wherein the set of component use datacomprises at least one of the end effector oscillation data or the endeffector time usage data, the method further comprising: (a) calculatinga cost based on at least one of the end effector oscillation data or theend effector time usage data; (b) displaying the cost, via theprocessor, on the display screen; and (c) transmitting the cost to oneor more manufacturers or vendors of at least one of the body, thedetachable transmission assembly, or the end effector.
 3. The method ofclaim 1, further comprising analyzing one or more patient files togenerate a report on a surgeon-specific usage of at least one of thebody, one or more detachable transmission assemblies, or one or more endeffectors.
 4. The method of claim 1, further comprising: (a) creating ause cost based upon the set of component use data, wherein the use costdescribes an overall cost of use associated with the surgical instrumentduring the medical procedure on the first patient; (b) displaying theuse cost, and displaying a second use cost created during a secondmedical procedure for a second patient; and (c) identifying a desirablesurgical instrument component based upon the use cost and the second usecost, wherein use of the desirable surgical instrument component isassociated with a lowest cost of use.
 5. The method of claim 1, wherein:(a) the one or more unique identifiers comprise identifiers associatedwith each of the detachable transmission assembly, the end effector, andthe body of the surgical instrument; (b) the set of performance datacomprises data separately describing the use of each of the detachabletransmission assembly, the end effector, and the body of the surgicalinstrument during the medical procedure; and (c) the set of componentuse data comprises individual use data for each of the detachabletransmission assembly, the end effector, and the body of the surgicalinstrument.
 6. A method comprising: (a) associating one or more uniqueidentifiers with one or more components of a surgical instrument, thesurgical instrument comprising one or more sensors, a memory, and agenerator, wherein the memory is configured to store the one or moreunique identifiers, wherein the generator is communicatively coupled toa server through a secure gateway; (b) capturing a set of operation datavia the one or more sensors, the set of operation data describing one ormore aspects of a use of the surgical instrument during a medicalprocedure; (c) storing a secure key on the secure gateway; (d)transmitting the one or more unique identifiers and the set of operationdata to the secure gateway; (e) requesting a remote secure key from theserver and, where the secure key is validated by the remote secure key,transmitting the one or more unique identifiers and the set of operationdata to the server; and at a database communicatively coupled with theserver, storing the one or more unique identifiers and the set ofoperation data.
 7. The method of claim 6, further comprising: (a)configuring the database to store different types of operation datacomprising two or more of the following: (i) duration of use, (ii)voltage conditions during use, (iii) total current used, or (iv) numberof activations; (b) associating the one or more unique identifiers andthe set of operation data with a patient data, the patient dataidentifying a patient on which the medical procedure was performed; and(c) calculating an overall cost of use for the surgical instrument forthe medical procedure based upon the set of operation data.
 8. Themethod of claim 7, further comprising comparing the overall cost of usefor the surgical instrument with a second overall cost of use for asecond surgical instrument and displaying the results via a computercommunicatively connected with the server.
 9. The method of claim 7,further comprising transmitting the overall cost of use to a third partyserver as part of a commercial transaction.
 10. The method of claim 7,further comprising configuring the server to: (a) display a first graphview in response to a request for the first graph view, wherein thefirst graph view shows steadiness of the surgical instrument and unitsof force applied to the surgical instrument during a period of time; (b)display a second graph view in response to a request for the secondgraph view, wherein the second graph view depicts power measured inwatts generated by the surgical instrument and voltage measured in voltsassociated with the surgical instrument during a period of time; (c)display a third graph view in response to a request for the third graphview, wherein the third graph view depicts frequency slope measured inhertz per second and current measured in amps during a period of time;and (d) display a fourth graph view in response to a request for thefourth graph view, wherein the fourth graph view depicts frequencymeasured in hertz per second during a period of time.
 11. The method ofclaim 6, further comprising: (a) determining, from the set of operationdata, that a surgeon has used the surgical instrument in a potentiallydangerous manner; and (b) adjusting the power provided by the generatorto prevent unnecessary injury.
 12. The method of claim 11, wherein thepotentially dangerous manner is applying an unnecessary amount of forcewhile using the surgical instrument.
 13. The method of claim 6, furthercomprising: (a) associating the one or more unique identifiers and theset of operation data with a patient data, the patient data identifyinga patient on which the medical procedure was performed; and (b)displaying, via a computer communicatively connected with the server,the surgical instruments associated with the patient through the one ormore unique identifiers and at least a subset of the set of operationdata associated with the patient.
 14. The method of claim 6, furthercomprising configuring the database to store different types ofoperation data comprising two or more of the following: (a) steadinessof the surgical instrument over a period of time; (b) speed of a cuttingportion of the surgical instrument over a period of time; (c) pressureon a cutting portion of the surgical instrument over a period of time;(d) power generated by the surgical instrument over a period of time;(e) voltage conditions for the surgical instrument over a period oftime; tissue impedance for a tissue the surgical instrument is beingapplied to over a period of time; (g) current supplied to the surgicalinstrument over a period of time; or (h) frequency of a moving part ofthe surgical instrument over a period of time.
 15. The method of claim6, wherein the database is configured to store sensor data originatingfrom two or more of the following: (a) a piezoelectric accelerometer;(b) a gyroscope; (c) a pressure sensor; (d) a force transducer; (e)acoustic impedance sensor; (f) thermal sensor; or (g) electricalimpedance sensor.
 16. The method of claim 6, wherein the memory isconfigured to store unique identifiers corresponding to: (a) a removableend effector; (b) a transmission assembly; and (c) a handle assembly.17. The method of claim 6, further comprising configuring the databaseto store a custom note, wherein the custom note is associated with theset of operation data, and wherein the custom note describes a conditioninfluencing the generation of the set of operation data.
 18. A methodcomprising: (a) associating a set of unique identifiers with componentsof a surgical instrument, the surgical instrument comprising a set ofsensors, a memory, a generator, a removable end effector, and atransmission assembly, wherein the memory is configured to store the setof unique identifiers, wherein the generator is communicatively coupledto a server; (b) generating a set of operation data via the set ofsensors, the set of sensors comprising one or more of a piezoelectricaccelerometer, a gyroscope, a pressure sensor, a force transducer, or athermal sensor, the set of operation data describing one or more aspectsof a use of the surgical instrument during a procedure being performed,the set of operation data comprising: (i) data captured by the set ofsensors, (ii) a duration of use for the surgical instrument, and (iii) anumber of activations for the surgical instrument; (c) transmitting aprocedure type, the set of unique identifiers and the set of operationdata to the server, wherein the procedure type describes the procedure;(d) at a database communicatively coupled with the server, storing theset of unique identifiers and the set of operation data; (e) determininga cost associated with the use of the surgical instrument based on theset of operation data; (f) tracking costs associated with a plurality oftypes of medical devices in the database; and (g) determining a devicetype that is associated with a low cost of use based on the trackedcosts in the database.
 19. The method of claim 18, further comprising:(a) receiving a set of calibration data from the surgical instrumentduring a calibration procedure performed by a surgeon on a sample oftissue, wherein the set of calibration data describes one or moresurgeon tendencies displayed by the surgeon during the calibrationprocedure; (b) using the set of calibration data to configure a set ofperformance characteristics of the surgical instrument, the set ofperformance characteristics comprising a power output of the generator,wherein the set of performance characteristics are configured tocompensate for the one or more surgeon tendencies; (c) transmitting theset of performance characteristics to the surgical instrument; and (d)configuring the surgical instrument based upon the set of performancecharacteristics.
 20. The method of claim 19, wherein a surgeon tendencyof the one or more surgeon tendencies indicates a tendency to apply anabnormally high force to tissue, and wherein a compensatorycharacteristic of the set of performance characteristics is configuredto cause the generator to reduce power to account for the abnormallyhigh force.